Healthcare Provider Details

I. General information

NPI: 1083385801
Provider Name (Legal Business Name): AMY HUFSTEDLER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2021
Last Update Date: 09/22/2021
Certification Date: 09/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3593 MEDINA RD # 181
MEDINA OH
44256-8182
US

IV. Provider business mailing address

3593 MEDINA RD # 181
MEDINA OH
44256-8182
US

V. Phone/Fax

Practice location:
  • Phone: 330-536-3746
  • Fax: 330-267-4250
Mailing address:
  • Phone: 330-536-3746
  • Fax: 330-267-4250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberLPN.131561
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: